Lumbar spine Not Finished Flashcards
disc injury is due to acute trauma alone (true or false)
degenerative mostly
90% of the time, disc herniations occur at L?
L4/L5. L3/4 is second most common
Disc bulge pain looks like ____and disc bulge against nerve root looks like _____
dull deep poorly localized, while nerve is sharp
most disc bulges occur in what area of the disc?
In posterior lateral aspect of the disc
mechanism of injury for disc pathology: What happens at the muscular level and circulatory level?
Body will contract large muscles in response to inflammation that shuts down local muscle fibers. Lack of motion impedes circulation, so irritants do not leave the region
what tight muscles contribute to lumbar disc pathology?
hip flexors, hamstrings
Disc pathology stiffness and pain in the AM lasts _____
more than 20 min
Easing activities for lumbar disc pain
lying down w knees/hips flexed (decreased disc pressure 75%)
meds
walking (circulation to disc)
lumbar extension motion
why do repetitive extension exercises help with leg paresthesias? (known as centralization)
When annulus is intact, nucleus/disc contents move anteriorly (anterior translation).
degenerative joint disease leads to ____ of articular surfaces in facets and results in loss of _____. Inflammatory cascade can result in ______.
breakdown of lumbar spine facet articular surfaces with loss of cartilage and disc height. Bone spurs/osteophytes can occur
symptomatic lumbar DJD is rarely found in people ____ years old. More common in ____ years old
rare in younger than 40 years old. More common in older than 60 years old
physiologically, what happens in lumbar DJD?
hyaline cartilage breaks down–> inflammation–> thickening/sclerosis of subchondral bone–> bone spurs/osteophytes–>narrow joint space
does DJD present unilaterally or bilaterally?
usually unilaterally in back and glutes (facet joint pain tends to be localized)
what are good ideas for reducing lower back pain?
increase thoracic mobility (extension), shoulder extension/retraction, stretch hip flexors, stretch plantarflexors and hamstrings
(also abs)
Is interforaminal stenosis from acute trauma or degeneration?
Wear and tear. Injury to joints, ligaments, disc, nerves leads to inflammation of the foramen
Do extension exercises aggravate or ease interforaminal stenosis?
aggravate! close down foramen (closing motions)
3/10 people with back pain also have ______
radiculopathy. Most cases resolve 1 to 2 months.
leg pain is often worse than back pain for patients with ______
radiculopathy
what direction do herniated lumbar discs go?
posterior-lateral, impinging nerve roots
What nerve roots are involved usually in radiculopathy?
L4-S1 (symptoms below knee)
indicators for surgery for patients with lumbar radiculopathy
neuro deficit
cauda equine syndrome
bowel/bladder dysfunction
severe unrelenting pain
lumbar ligament tears have bad or good prognosis?
excellent! over 90% of patients recover 1-2 months
80% of people experiencing LBP can be attributed to
soft tissue injuries/sprains/strains
The weakest point of ligaments for elderly and young is ______-
ligament to bone intersection
The weakest point of ligaments in adults is often at _______
midsubstance (will vary with each individual ligament)
why are partial ligament ruptures common? Vs full rupture
Bc ligaments are multipennated, resist forces in multiple directions
Ligament sprain is usually caused by trauma as opposed to overuse (true or false)
true
ligament tears have referred pain to LE (true or false)
FALSE. Pain is localized and increased with stretching ligament (end range postures)
Most common lumbar muscle strain is the _____muscle
erector spinae muscle
How long does it take for lumbar strains to heal?
4-12 weeks. Symptoms of mild strains usually 2-3 weeks. Over 90% recover in 1-2 months
In elderly and young, the weakest point of muscle is
tendon to bone intersection
In most adults, weakest point is at
myotendinous junction
The major risk factor for LBP is_____
history of back pain. **main cause is mismatch workload and patient strength
Muscle sprains have what symptoms?
-resisted extension moment
-pain that usually does not radiate
-tenderness/spasm
-passive trunk extension is PAIN FREE
what 3 pathologies do not like lumbar extension?
interforaminal stenosis, spondylolisthesis, and muscle strains
Spondylolysis most commonly occurs at
L5, then L4
Spondylolisthesis most commonly occurs at what level?
L5/S1, then L4/5, then L3/4
Four grades of spondylolisthesis are
1: 0-25%
2: 25-50%
3: 50-75%
4: 75% +
5 types of spondylolisthesis
- dysplastic
- isthmic
- degenerative
- traumatic
- pathological (tumor, metastases, metabolic bone disease)
dysplastic spondylolisthesis occurs due to
congenital -rare, difficult to treat surgically
isthmic spondylolisthesis is
maybe from stress fracture, shear forces. Most common L5/S1.
degenerative spondylolisthesis
slippage of superior vertebral segment from facet arthritis
traumatic spondylolisthesis
acute fracture of facet/pars interarticularis
forced extension usually causes spondylolysis (true or false)
true (L5, then L4, then L3)
spondylolisthesis will always have symptoms (true/false)
NO, false. But, if they due, pain in back, legs with increased extension
Gold standard for verifying SI articulation pain source
intraarticular anesthetic injections
What gender is more at risk for SI joint pathology?
Women, most common correlation is pregnancy
Why is there less referred pain for SI joint pathology?
S2-4 (referred pain usually has to do with higher like lumbar)
